Making dollars & sense from Transparency in Coverage MRFs

Traditional methods for measuring physician quality in workers’ comp have used quality measures based on adverse events: mortality rates, hospital readmissions and, in terms of Workers Comp, delayed return to work. As such, the process for selecting WC Network Physicians, may unintentionally overlook providers who do a better job of treating injured workers impacted by Social Determinants of Health (SDOH). Why? Because injured workers with SDOH factors such as restricted access to care, low income or education, lack of transportation and housing are the workers most likely to experience adverse health outcomes. Providers treating that group are measured poorly – not due to the quality of their medical care, but because of adverse events coming from SDOH factors totally out of their control.